Quote of the day

Dr. Grumpy: "Any side effects with the medication?"

Mr. Colon: "Yeah, I'm constipated. I've been using Miralax, Sennakot, Colace, and some other stuff. You know how it goes. It takes a village to have a shit."

Skool nerse time

This is Mrs. Grumpy.

My, how did the Summer go by so quickly? Well here we are again, in the first week of school.

As always, I have the cherished task of sorting out the "medical information cards" you parents fill out. I'm sure in this day and age it could be done more effectively online, but apparently they tried that at another school last year, and the parents didn't bother. I guess the internet kiosk line at the bus station was too long.

So we're continuing with cards.

Since filling these things out is a surprisingly complex task for so many of you, I thought I'd offer a few pointers.

1. On the line where it says "name" write YOUR KID'S NAME. Not your name. Or his sister's name. Also, putting nicknames like "Raggy," "Dudette," and "Booger," while cute, do not help. Especially when you don't put on a last name. So, let's keep this in mind: Write your KID'S name, both first and last. Middle is optional, unless it's a name that ends in a Roman numeral (such as Harold Winthrop Higgleschweimer IV). Then it's required so the teachers know he's just killing time with school until he gets his inheritance.

2. On the line where it says "medications" please list any your kid is taking. Things your ex was taking at the time of conception that you believe explain junior's shitty math scores do not belong there. Nor am I looking for a list of EVERY FUCKING PILL BOTTLE IN THE HOUSE. Just what junior is presently on, not what he might get into because of crappy supervision by your baby-daddy's 9 year old watching him and playing Nintendo simultaneously.

3. Under allergies, please write your kid's allergies. That's all. How hard is that? Peanuts? Check. Penicillin? Good, you've got the point. So stop putting stuff in like "soap from a Motel 6," "the sunscreen my MIL bought," and (my favorite this year) "Disney backpacks."

4. I need a phone number where I can reach you in an emergency. 911 doesn't count, unless you work there. And even then, it's a stretch. Likewise, telling me that it changes from week-to-week doesn't help, and makes me wonder if CPS should be called.

5. A vaccination record is really helpful. Writing "I believe in Jenny McCarthy" doesn't make me think highly of you. But my REAL pet peeve here is those of you who are simply too damn lazy to actually look for the records, and just scribble "religious reasons" to save time in filling it out. If that many of you hadn't vaccinated your kids, most would be dead by now. I don't believe you, so get off your ass and look through the filing cabinet.

6. If junior takes pills, please bring them in a labeled prescription bottle. A plastic baggie that says "Give a blue pill to Joanie once a day" isn't helpful. Nor is dumping a handful of loose unidentifiable pills on the counter and mumbling "those are for Steve" as you rush out with a phone glued to your ear.

7. I am not the NSA. I am not trying to violate your privacy here. I really do need to know if your kid has epilepsy. Or diabetes. Or asthma. This is knowledge that can make the difference between Billy living or dying when he's brought to my office sick as shit. Writing "none of your business" or "PRIVATE!!!" on the medical history section doesn't make my job easier. If you're writing it because you're too lazy to call your ex and ask about medical history, grow a pair and and do it. This is about your kid, not you.

Have a great school year!

For more skool nerse stories, please see my page.

Pop quiz!

Time for another contest, class:

These gadgets were in an MRI-supply catalog that (for unknown reasons) showed up at my office. So let's forget I told you that.

Take out your #2 pencils, and try to come up with some creative answers as to what they might be. I've already started you off with three ideas. 

These items are:





A. The latest in BDSM equipment.

B. Props from the next Hannibal Lecter movie.

C. Um... stuff used in a new Olympic sport? From, uh, that country over on that other continent?

Kid quote of the night

"Dad, you can tell this book takes place in the olden days, because the girl has a tape recorder."

Thanks, Marie.

Mary's desk, August 26, 2013

Mr. Stapes: "Hello?"

Mary: "Hi, Mr. Stapes. It's Mary at Dr. Grumpy's office."

Mr. Stapes: "Can you speak up?"

Mary: "HI, MR. STAPES. IT'S MARY, AT DR. GRUMPY'S OFFICE."

Mr. Stapes: "Oh, hi, Mary. Wasn't I just there a short while ago?"

Mary: "Yes. I'm calling because you left your hearing aids in Dr. Grumpy's exam room."

Mr. Stapes: "What?"

Mary: "YOU LEFT YOUR HEARING AIDS IN DR. GRUMPY'S EXAM ROOM."

Mr. Stapes: "I'm sorry, I have to hand the phone to my wife. I can't find my hearing aids."

Sunday night

 

My cell phone rings.

Dr. Grumpy: "This is Dr. Grumpy."

Dr. Nerve: "Hi, Ibee" (pant, pant, pant, loud thumping noise) "I'm just calling to give you the post-call check-out" (thump, thump, thump) "In room 752 is the guy you saw Friday..."

Dr. Grumpy: "Are you okay? What's all that noise?"

Dr. Nerve: "I'm running" (pant, pant, thump, thump, thump) "on my treadmill."

Dr. Grumpy: "Why don't you call me later? I can barely hear you."

Dr. Nerve: "No! (pant, thump) "I'm determined to get back in shape!" (pant, thump, pant, thump) "Anyway, the guy in 752, Mr. Smith, had another seizure last night..." (pant, pant, thump...)

Dr. Grumpy: "What did his MRI show?"

Dr. Nerve: (thump, pant) "Hang on, let me get the list. I set it next to..." (thump) "AAAAAAAHHH!" (crash, thud) "SHIT!!!

click

Found in a shopping cart at Local Grocery

Patient quote of the day

"Why do I have to let you know whenever I have a seizure? You're not my fucking mother."

More survey fun

I've put up some of the weird/stupid/random questions I've seen on surveys in the past. Apparently these aren't limited to North America.

A reader from the other side of the planet (Australia) sent this excerpt from one he recently took:

It's the 4th item down that grabs my attention.

Let's face it: everyone has their own degree of what is and isn't comfortable. But if I've reached a point in my life where I'm having an autopsy, I'm pretty sure I'm not going to care one way or the other.

Thank you, Caillin!

Oh, I'm sure they're used to your type

Dr. Grumpy: "This is Dr. Grumpy, returning a page."

Mr. Platelet: "Hi, I need you to call the pharmacist about my Plavix."

Dr. Grumpy: "What's wrong? I thought Annie called it in earlier today?"

Mr. Platelet: "Yeah, but they're trying to pull a fast one on me. They tried to give me something called Clopidogrel, and they're telling me it's the same. And I've never taken Clopidogrel!"

Dr. Grumpy: "It is the same. Clopidogrel is just the generic name."

Mr. Platelet: "It is?"

Dr. Grumpy: "Yeah."

Mr. Platelet: "Oh crap. Normally my wife picks it up for me, too. I've just never noticed."

Dr. Grumpy: "Same drug. Just go get it."

Mr. Platelet: "Um, can you call it in to another pharmacy for me? After the way I acted I'm too embarrassed to go back there now."

Pizzaball

The Grumpyville city summer sports leagues are always popular, with different divisions for all levels of talent.

Usually one of the best teams in town is 8 guys who all work at Local Pizza. The manager there is the husband of one of my patients. The Pizza Boys have a feared reputation in their division, as they've been friends since high school and play together year round. They've only rarely been defeated.

Until this month.

Mrs. Pizza came in for a routine visit, and I asked how her husband's team did this year.

She paused, then began laughing. Hysterically. When she finally calmed down she told me they'd lost EVERY. SINGLE. GAME. By huge margins, too.

I asked her how this could happen. Was one sick? Injured? Dead? These guys are good (at least by city league standards).

And she began laughing again.

Apparently, due to a busy day at the restaurant, they sent one guy's girlfriend to sign them up at the city park that runs the leagues.

She signed them up for division 5 (normally they play in division 3) by mistake.

Division 5 is guys who are either recently-retired from the NBA, or who came really close to getting into the pro leagues, but weren't quite good enough.

But they are, however, a helluva lot better than a bunch of guys who run a pizza joint.

I was laughing so hard it pretty much ended the visit.

Important details

Seen in a chart while on call this weekend:

FOR FUCK'S SAKE, NO!!!

Seen at Costco, in adjacent aisles, on August 18, 2013:

Once again, my pleas go unanswered.

"I love what you've done with the conning tower!"

While doing some reading about naval battles in the Mediterranean during WWII, I stumbled across this profile of a U-Boat commander.

It was the last line that gave me the giggles.

Patient quote of the day

"We've been trying to get pregnant for a year, but took a break last month to get married."

Downgraded? Wishful thinking? Fight in my lobby?

From the "Emergency contact" section of a patient information form a woman filled out yesterday:

Mary's desk

Mary: "Okay, so we'll see you next Tuesday at 8:15. Any questions?"

Mr. Letter: "I know your office complex pretty well, but where are you in relationship to the 1st floor post office?"

Mary: "There isn't a post office in our building."

Mr. Letter: "Yes there is. I was just in it last month to mail a package. It's on the west side of the first floor."

Mary: "Sir, I assure you, this is a medical building. There isn't a post office anywhere in here."

Mr. Letter: "They must have closed it. It's across from the elevator. How could you not see it?"

Mary: "We've been in this building for over 10 years, sir. There's no post office here. The nearest one is about 4 miles away."

Pause

Mr. Letter: "Are you sure Dr. Grumpy isn't in the building with the post office?"

Mary: "Yes sir. Do you want me to give you our address? You can see a map on our website..."

Mr. Letter: "Why don't you just cancel the appointment. I need to buy stamps and send a package to my cousin, so I'll just try to find a neurologist closer to a post office."

Negative answers FAIL

Dr. Grumpy: "Do you use caffeine?"

Mr. Negative: "No, except for 2 cups of regular coffee each day."

Dr. Grumpy: "Do you take any medications?"

Mr. Negative: "Nope. Only Coumadin and Metformin."

Dr. Grumpy: "Are you allergic to any medications?"

Mr. Negative: "None, just Penicillin."

Don't just stand there! DO SOMETHING!

I hear that all the time. Apparently, standing by the bedside and giving medications isn't enough for some people.

There's a pervasive idea that a high-priced invasive procedure has to somehow be better than doing something simple and conservative. I suppose this is human nature. Our ancestors gravitated toward human sacrifice on the instinctive belief that a deity that demanded human life has to be more powerful than one who wanted rice.

And I'm not knocking surgery, or surgeons, or other invasive procedures. In many cases they are critically important and life saving.

But let me tell you some stories.

The cardiologists have a remarkable technology called the stent. It's a tiny piece of metal that can help prop open a closing artery to restore blood flow. It's changed a lot of the way heart care is practiced during my career.

So it's only natural to extrapolate this technology to arteries of the brain. Instead of doing surgery, or using ho-hum medicines, we started putting high-tech stents into arteries supplying the brain, too.

Guess what? A study found boring old pills beat snazzy stents!

Here's another example:

For acute strokes, TPA is the big thing (I'm not going to argue about how effective it really is). But there's all kinds of things we can do beyond just plain old TPA. After all, how exciting is it to slowly drip some liquid into an IV line?

(crickets)

But it can be so much more exciting! What if we give TPA by threading a catheter all the way up to the brain and drip it right onto the clot? COOL! Or we could also use REALLY flashy technology ("technology always implies it MUST be good, doesn't it?). There are tiny gadgets we can thread all the way up to the brain, screw them (gently) into the clot, and pull it out (WOW! Like a cork!). Or another gadget we can use to punch a whole in the clot and restore blood flow.

Sounds all science fiction-y, huh? Well, we DO have the technology to do all those things.

But does it work? (Wait, who DARES ask such a question of advanced technology?!!!)

Um, no.

That's it folks. 2 studies (here and here) found that all this advanced stuff was no better than boringly watching TPA drip into an IV line. Ho-hum.

Now, the companies who make the fancy gadgets, and the doctors who use them, will gladly point out all kinds of flaws in the studies, and some of them may be legitimate. But some complaints, like "we need to select patients better," translate simply as "let's stack the deck in our favor."

In medicine we hear the phrase "Do something!" a lot. But usually we already are doing something. The problem is that many people think that unless it involves a lot of razzle-dazzle and medical voodoo, we aren't.

And in some cases that's quite far from the truth.

Yet more pictures from the road

I suppose only a neurologist would notice this guy's T-shirt:

Here we have a fashion statement, albeit for a good cause:

 

I don't understand this:

"I want you to remember this, Clark. The one man who hung you from his radiator grill."

More pictures from the road

This bio-hazard bag rode an elevator at our hotel for roughly 24 hours before disappearing. Maybe they wanted us to think we were aboard the Carnival Triumph.

I assume this bumper sticker's purpose is to confuse readers regardless of political leaning.

Catching up on some reading behind-the-wheel while Mrs. Grumpy was driving, I encountered this strange ad for an epilepsy drug. Apparently, if you don't like turning blue, it's easier to be green.